Clinical Research Directory

The conventional physiotherapy program was delivered for 45 minutes per session, twice weekly for 8 weeks. The program was individualized according to the child's age, functional level, cooperation, severity and type of involvement. It included passive, active-assisted and active range of motion exercises for the shoulder, elbow, forearm, wrist and fingers; selective strengthening exercises for scapulothoracic and upper extremity muscles; stretching of shortened muscles and soft tissues using static manual and PNF techniques when indicated; age-appropriate functional upper extremity activities such as reaching, grasping, releasing, carrying, bimanual tasks and activities of daily living; sensory-motor stimulation activities; trunk mobility and stabilization exercises; static and dynamic balance exercises; and a home exercise program.

The graded motor imagery program was applied in addition to conventional physiotherapy for 15 minutes per session, twice weekly for 8 weeks. The program consisted of three sequential phases. During weeks 0-2, lateralization training was performed using Recognise™ Hand and Recognise™ Shoulder applications. During weeks 2-6, explicit motor imagery training was applied according to PETTLEP principles, progressing from simple upper extremity movements to individualized functional and participation-based activities. During weeks 6-8, mirror therapy was performed, progressing from distal hand and wrist movements to proximal, reaching and functional upper extremity tasks. Participants were instructed to focus on the visual or imagined movement without actual movement during imagery tasks and to perceive the mirror reflection as movement of the affected extremity during mirror therapy.